Mutism and its types, symptom of mental and neurological origin, treatment

Mutism is a pathological condition characterized by complete silence while maintaining the functions of the speech apparatus, hearing and the ability to understand speech. In neurology, this disorder is classified as a neurotic speech disorder, in psychology - as a violation of the ability to establish social contacts, in psychiatry this phenomenon is considered within the framework of mental disorders (schizophrenia, psychosis, hysteria).

Currently, the disorder is commonly referred to as “behavioral and emotional disorders that begin in childhood and adolescence.” The diagnosis is included in the list of diseases included in the International Classifier.

What is selective mutism

The name is translated from Latin as “selective muteness.” With selective mutism, the ability to speak is preserved, but in certain situations or with specific people it becomes silent and cannot utter a word. This is usually caused by a sudden onset of anxiety. At the same time, in other cases - with close people, in the family, with friends, he communicates freely, is relaxed, sometimes even talkative.

Selective mutism most often appears in childhood and adolescence, and is very rare in adults.

Emotional reactions in mutism

Akinetic mutism is a condition in which the patient completely loses speech, but the ability to speak remains. There is a lack of facial expressions and gestures, but the patient hears someone else's speech and understands it. He adequately perceives and reacts to events happening around him. He is well oriented in space and time. Positive reactions are observed with loud sounds and temperature changes. There are no hallucinations or delusional states. Despite all the reactions, the patient is in a supine state. He is not active, he is only able to move his gaze from object to object, but for a short time.

One of the types of mutism is a psychogenic type of disease, provoked by psychological trauma. There are cases when this condition manifested itself in a selective form, when the patient spoke only to selected people.

Types of disease

Passive-aggressive - the child tries to influence adults with his silence for his own purposes. For example, a mother refuses to buy a toy for her child, and in response, he stops talking to her for several hours. By this he is trying to demonstrate his feelings: resentment, anger, anger, disappointment.
Symbiotic - the child has very strong connections with the closest people, for example, with parents. He freely communicates and interacts with them. At the same time, he is unable to talk with other people. He understands their speech, but is not ready to answer them.
Reactive – formed as a result of psychological trauma.
Speech phobic - the reason for this mutism is that the baby is afraid to hear his own voice or is worried that he will say something wrong.

Definition of the syndrome

A patient with akinetic mutism syndrome is unable to move; he is in a lying position around the clock, without uttering a word. The only constant reaction is the movement of the eyeballs, which monitor what is happening around. At the same time, a person cannot focus his gaze for a long time.

The patient understands everything that is happening around him, gives events a semantic assessment, but is not able to voice it or express it with movement. If the patient is exposed to bright external stimuli, such as the light of a lamp in the eyes, loud sounds, painful sensations, this leads to reactive movements. The syndrome is also called “waking coma”, since the patient is conscious, but is not capable of full activity.

This condition can last for weeks or months and is often irreversible. If speech and motor function were nevertheless restored, the patient cannot clearly describe what happened to him at the time of such a coma. Some patients claim that they were fully conscious throughout their illness, but when they tried to utter a word or move, they were held back by some “unknown force.” The disease is rare, and those who suffer from it often do not even know it.

Symptoms

The main symptom of selective mutism in children is the loss of speech in some specific situations. For example, a child may become silent in front of a large number of people or when seeing doctors in white coats.

Most often, a child becomes silent in educational and educational organizations: in kindergarten or school. At the same time, the child can freely communicate with classmates or classmates, and when teachers in general or any specific teachers appear, they can remain silent. If it is necessary to assess the level of development of a child, it is better to conduct a written diagnosis with him.

Typically, a person suffering from selective mutism tries to interact with others through nonverbal communication: through facial expressions and gestures. But there are children who in certain situations cannot even move: they freeze, try not to make tactile contact, and hide their heads.

The child’s behavior in stressful situations becomes incomprehensible to most people around him. Obsessive movements appear: fingering his fingers, biting his nails or skin on his fingers, twirling his hair, arranging objects according to signs that only he understands, constantly washing his hands. With these actions a person tries to relieve internal tension and anxiety.

At school, a student can be shy and timid, but at home he can unload psychologically with the help of aggression, disobedience and stubbornness.

Often a preschooler or first-grader suffering from selective mutism is too strongly attached to his mother and cannot psychologically distance himself from her. Against the background of anxiety and constant nervous tension, other symptoms develop: delayed speech development, nervous tics, problems with the articulatory apparatus.

Accompanying illnesses

Due to the fact that the speech apparatus does not work for a long time, it suffers from spasms, and other diseases and disorders arise against the background of elective mutism.

Impaired mental function. The child does not pronounce important information and cannot fully master logical operations: analysis, synthesis, comparison, classification. This occurs in cases where parents, for some reason, do not themselves work with the child in conditions where he is comfortable and can speak.
Delayed speech development. The less the speech apparatus and the brain structures responsible for speaking are trained, the more the child will lag behind his peers in speech development. The situation worsens for children in whose families the parents do not have the opportunity or desire to communicate with the baby as often as possible.
Nervous tics. A child suffering from selective mutism is usually anxious and tense. The nervous system, trying to unload itself, turns on mechanisms that perform twitching of certain muscles or their groups, independent of the person.
Enuresis. Anxious children often suffer from this disorder, which does not depend on their conscious choice to go to the toilet or not.

Difference between selective mutism and traumatic mutism

Children who suffer from selective mutism sometimes speak and rarely shut down in certain situations. Most of them are depressed and exhibit social anxiety. For children with selective mutism, their mutism is a means of avoiding anxious feelings caused by expectations and social encounters.

In children with traumatic mutism, mutism usually develops suddenly in all situations. An example would be a child who witnesses the death of a grandparent or other traumatic event and is unable to process the event and shuts down in all situations.

Causes

Selective mutism is formed as a result of the influence of a combination of basic psychological characteristics and environmental factors. The following causes of the disease can be identified:

Intrafamily conflicts. The child may experience unconscious anger or fear related to relationships within the family. The baby resorts to this style of behavior in order to demonstrate his feelings, although, most often, he is not aware of this.
Negative gain. This usually refers to behavior during the period of adaptation to a new institution. The child, through his silence, tries to influence the attitude of other people towards him. For example, in his mind, if he does not speak, then his workload will be reduced. This is also an unconscious process; the child does not shut up on purpose. Mutism in this case is associated with increased anxiety, and not with conscious manipulative behavior.
Personal and emotional characteristics. Children with increased anxiety, suspiciousness, and phobias most often experience selective mutism. Vulnerable, impressionable, introverted children and children with suppressed aggression are also at risk for mutism.
Deviations of mental development also contribute to the formation of the disease. Such disorders include delayed mental and speech development. If a child is not confident in his mental abilities or realizes that his speech is not clear enough, then he often withdraws and does not speak when surrounded by people who, in his opinion, might laugh at him or offend him on this basis.
Neurological disorders, such as traumatic brain injury, tumor or hematoma, provoke the child to remain silent in certain situations.
The type of upbringing that has developed in the family determines the child’s behavior. Selective mutism occurs either in families with very anxious and insecure parents due to overprotection, or in families with total control and an authoritarian parenting style due to the child’s fears.
Stressful situations that have a strong impact on the psyche can trigger the development of mutism. This often happens after accidents, parental divorce, violence, or moving to another city or country.

Selective mutism usually develops in connection with congenital characteristics that are influenced by external circumstances: the relationship of mom and dad, stress, anxiety, and the behavior of other people.

Diagnostics

Selective mutism is determined by a neurologist or psychiatrist based on a comprehensive examination and the opinions of other specialists.

To begin with, the doctor interviews the parents to collect primary information: how the birth went, what problems there were during pregnancy and after its end, whether any neurological, psychological or speech disorders were identified during the child’s life. The doctor is also interested in whether there have been head injuries or tumors.

During the appointment, the doctor observes the behavior of the little patient: assesses his communication needs, level of interaction with other people, and ability to establish contacts. It also reveals whether he is ready to participate in joint activities with someone, whether he is trying to communicate using facial expressions and gestures, and whether he has visible psychological depression.

For a more complete picture, a psychiatrist is involved in the examination. He performs standardized and projective diagnostic techniques to rule out serious psychiatric illnesses such as schizophrenia.

According to the nomenclature of mental disorders, there are several special criteria indicating the presence of selective mutism in combination with other diagnostic studies. These signs must be observed for at least one month.

Criteria for the presence of selective mutism:

knows how to speak and communicate, but in certain situations or in the presence of certain people he becomes silent;
there is no relationship between the child’s inability to speak and his poor knowledge of the language or topic of conversation;
temporary muteness has a negative impact on the child's learning or relationships with others;
muteness in certain situations is not associated with speech disorders or exacerbation of mental illness.

Stages of recovery

Conventionally, doctors distinguish two stages of recovery from akinetic mutism in neurology:

Restoring speech understanding. The patient lies with his eyes slightly open, turning his head towards the sound or light. There is a constant and stable fixation of gaze and tracking of objects. The completion of this stage is the first manifestation of speech understanding. This can be evidenced by the fact that the patient hears words addressed to him, his facial expressions change, and requests expressed in words are fulfilled, for example, to squeeze the doctor’s hand. But all manipulations take place gradually. First, the doctor places his hand in the patient’s palm, then the tasks become more complex every day, which provoke the patient to greater physical activity. They try to further practice more complex commands, with subsequent acceleration. Restoration of understanding of spoken speech indicates the absence of brain damage.
Return of one's own speech in akinetic mutism after coma. The patient makes more and more active and different movements. Pronunciation of words indicates the completion of the first stage. This cannot be spontaneous, more often in response to the doctor’s request to say something. The first sounds will be unclear. Only by individual signs can one guess what sound was uttered. Every day the situation improves, the patient begins to speak spontaneously, without requests. After some time, it is already possible to pronounce phrases. Then it will be possible to conduct a dialogue with the patient, which will allow an objective assessment of his state of consciousness. Together with the restoration of speech function, the forms of voluntary movements expand. They become orderly.

Treatment

When symptoms in children do indicate the presence of selective mutism, the doctor prescribes the necessary treatment. Complex therapy includes taking certain medications and simultaneously conducting psychotherapeutic work. Typically, the doctor recommends the following groups of drugs for treatment:

antidepressants - they relieve anxiety, mental overexcitation, and calm;
neuroleptics reduce symptoms of mental disorders, including neuroses, insomnia, phobias;
benzodiazepines are prescribed to relieve fears, physical relaxation during muscle spasms, and general calm;
nootropics help the body resist stress.

Treatment can be carried out both at home and in a hospital. The duration of the course is determined by the doctor. The sooner drug treatment begins, the greater the chances of a full recovery.

Medicines help the nervous system recover, but it is also necessary to restore self-esteem, the ability to interact, and speech skills. Therefore, in combination with medications, it is necessary to use the work of a psychotherapist and speech therapist.

The following types of psychotherapy are usually used to correct selective mutism in children:

Behavioral therapy. It allows you to learn how to translate the phenomena of fear and anxiety into positive thoughts and beliefs. The child begins to realize his condition, comes to understand how he can help himself and why this is needed: for interaction, for communication, for informing someone about something important.
Art therapy helps to relieve physical and psychological stress, feel self-confidence and increase self-esteem.
Fairy tale therapy allows you to see yourself from the outside, figure out how you can overcome your fears and anxieties, emotionally relax and express yourself.

How to help a child: advice to parents

Try not to encourage your child to engage in avoidant behavior from early childhood. For example, if a person a mother knows asks the child his name, then you should not answer for him, even if he hides his face and is silent. Otherwise, the baby will get used to the fact that in a situation of embarrassment and anxiety, his mother will say everything for him. The more often this is repeated, the more likely it is that he will stop talking altogether in situations that are uncomfortable for him. It is better to tell your friend that your daughter or son is not ready to communicate now, but perhaps you will be able to do this later.
Increase self-esteem. If a child knows from childhood that he is good, that his voice sounds pleasant and no one scolds him for unclear speech, then he most likely will not suffer from mutism. It’s good when he is praised, encouraged, and sometimes admired for what he does and says. When a child from an early age hears several times a day: “your voice is too loud”, “don’t shout”, “don’t distort your words”, “be quiet”, “they didn’t ask you”, then over time he will decide that it’s better not talking than constantly being criticized. He will be afraid of saying something wrong, of making a mistake, or of what he says being unimportant.
Introduce the child into society as early as possible so that a large number of people does not create a stressful situation for him. Bring them to playgrounds, meet friends, go to holidays and clubs where there are a lot of people. If mutism already exists, then at first try to select companies in which he feels comfortable: familiar children and adults, absence of judgment and ridicule, availability of common topics for communication. Later, gradually add less familiar peers.
If you have selective mutism, you should not expect speech to appear immediately at the beginning of treatment. For this, a certain time must pass, depending on the individual characteristics of the course of the disease.
When you find yourself in a new environment or surrounded by strangers, you should let yourself get comfortable a little before you can start communicating. There is no need to immediately force him to talk to everyone who approaches him - this can only worsen his condition.